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To assess the value of single photon emission computed tomography (SPECT) in the differential diagnosis of dementia SPECT and conventional computed tomography were performed in 77 patients (50 men, 27 women, mean age 59 [28-90] years) with dementia diagnosed by a battery of psychometric tests. In 13 out of 15 patients with dementia of Alzheimer type SPECT showed a typical Alzheimer pattern (bilateral parietotemporal perfusion defects). Both patients with dementia of Pick type had definite decreases in frontal perfusion. All 21 patients with dementia due to Huntington's chorea showed a typical pattern with absent perfusion of the head of the caudate nucleus, although in three of them conventional computed tomography didn't demonstrate complete atrophy of this structure. Out of 23 patients with multi-infarct dementia there were 17 with focal uptake deficits at various sites, while six displayed an Alzheimer pattern. In Korsakoff's syndrome (n = 11), Down's syndrome (n = 1), Fahr's syndrome (n = 2), senile chorea (n = 1) and HIV encephalopathy (n = 1) no typical distribution patterns were noted. Single photon emission computed tomography can make a contribution to the diagnosis and classification of primary degenerative dementias and can be used to differentiate them from other forms of dementia.

The only randomized data on heparin treatment in acute cerebral sinus venous thrombosis (CSVT) are derived from a small number of patients. The rate of intracranial hemorrhages as a complication of high-dose heparin treatment is still unknown. This retrospective study evaluates the clinical features, neuroimaging monitoring and outcome of 42 patients with proven CSVT. Diagnosis was established by DSA, CT, MR tomography and MR angiography. All patients received heparin intravenously guided by doubling the aPTT value for 3 weeks, followed by oral anticoagulation. Partial or complete recanalization was found in 36 cases. 40 patients improved clinically, in 26 of them complete recovery was observed. One patient deteriorated and developed an apallic syndrome, one further patient died of septic multiorgan failure. Only in one patient was hemorrhagic transformation of infarcted brain tissue observed but without clinical deterioration.

The new antiepileptic drug zonisamide was evaluated in a European multicenter parallel-group double-blind trial as add-on treatment for 139 patients with refractory partial epilepsy. During treatment with zonisamide complex partial seizures decreased by 27.7% compared to placebo (P < 0.05) and the median rate dropped from 12/month to 7.1/month with no changes in the placebo group (P < 0.007). During the 12-week double-blind phase a 50% reduction of all seizures was recorded in 29.9% of the patients treated with zonisamide vs. 9.4% during placebo. Complete remission was observed during treatment with zonisamide in 6.2%. The plasma concentrations of the concomitant antiepileptic drugs did not change markedly when zonisamide was added. Adverse events, mostly fatigue, somnolence, dizziness and ataxia, occurred in 59.2% of the patients compared to 27.9% during placebo. Zonisamide was withdrawn in two patients due to adverse events. Kidney stones were not observed nor any relevant clinical chemistry or hematological changes. Zonisamide is an effective antiepileptic drug for add-on treatment of refractory partial epilepsy.

After showing in an earlier publication that Iomazenil is a potent benzodiazepine receptor antagonist, the substance has been distributed to 11 clinical centres in Europe for further tests. The protocol asked for volunteers, epileptic cases and patients with Alzheimer's disease. Prior to the Iomazenil examination, flow images by perfusamine or HMPAO were required, and as comparative methods EEG, computed tomography (CT) and magnetic resonance imaging (MRI) were performed. The results allowed first the determination of the normal distribution of the benzodiazepine receptors in the human brain. The highest uptake was found in medial occipital cortex. Second, the evaluation of the epileptic cases shows a 100% positive prediction value for Iomazenil compared to 92% for flow images. Negative prediction values were calculated as 81% for Iomazenil and 54% for flow images. Furthermore, one group reported the successful diagnosis of Alzheimer's disease at an early stage. The visual image examination was tentatively compared to a more objective semiquantitative one based on quotients of corresponding left/right regions of interest. This semiquantitative method has not proved successful yet, but the problems have been identified. A more precise protocol for further studies is therefore proposed.

There were 273,722 hospitalizations due to neurological disorders reported in Austria's nonprofit hospitals in 1997, including the related operated cases (14.12% of all 1.9 million hospitalizations). The individual disease groups, e.g., cerebrovascular disorders (59,269 admissions or 3.06%), multiple sclerosis (3,920 admissions or 0.2%) are detailed and the cost resulting from these diseases were estimated according to the Austrian Diagnosis Related Groups. The number of hospitalizations due to psychiatric disorders was 99,346 (5.13%). According to our results, we were able to estimate that 6,492 beds (at the moment 2,053 beds) were required for inpatient treatment in the area of neurology and psychiatry, which means one bed per 1,260 inhabitants.

In 1997, 273 722 hospitalizations as a result of neurological disorders, including the related operated cases, were reported in Austria's non-profit hospitals (80% of all hospitals). They represent 14.12% of all 1.9 million in-patient treatments. The individual disease groups, e.g. cerebrovascular disorders (59 269 admissions or 3.06%), multiple sclerosis (3920 admissions or 0.2%) and all other groups are detailed. We estimated the cost resulting from these diseases which amounted to 11.88% of all hospital costs. We were also able to estimate that 5549 beds are required for in-patient treatment in the area of neurology, assuming an average duration of treatment of 8 days (Austrian mean value for neurological disorders). This is equivalent to one bed per 1367 inhabitants or 11.31% of all beds for in-patient treatment in non-profit hospitals in Austria. Obviously at present the majority of neurological patients are treated in non-neurological departments. A major increase in resources to neurology is necessary if patients are to receive the benefit of specialized diagnosis and treatment. These further resources not only cover the increase of neurological beds in hospitals but also financial, personal resources and in consequence increased capacity for neurological education, training and research.

Technetium-99m-hexamethyl propyleneamine oxime (HMPAO) and 99mTc-ethyl cysteinate dimer (ECD) accumulate in brain tissue in proportion to regional cerebral blood flow in healthy subjects and in patients with a variety of neurological diseases. We report on four patients with herpes simplex encephalitis and the discordance between these two approved cerebral perfusion imaging radiopharmaceuticals.SPECT images showed unilateral regional increase of 99mTc-HMPAO uptake and decrease of 99mTc-ECD uptake in the affected temporal lobe.

Two weeks after vaccination against tick-borne encephalitis (TBE), a 57-year-old female suddenly developed mental confusion and hemiparesis of the left side. Cranial MRI demonstrated extensive bilateral lesions in the fronto-parietal white matter of both hemispheres, suggesting an acute inflammatory demyelinating disease following vaccination. Despite administration of high-dose corticosteroids, the patient died 3 weeks after onset of neurological symptoms. Autopsy revealed diffuse infiltrates of a primary cerebral pleomorphic T-cell lymphoma of medium and large cell type. PCR on brain tissue for HTLV-I and serology for anti-HTLV-I antibodies in CSF and serum were negative; immunocytochemistry on brain tissue did not detect EBV-related antigen. This is the first recorded observation of a diffusely infiltrating primary central nervous system T-cell lymphoma, clinically and radiologically mimicking a fatal acute inflammatory demyelinating complication after vaccination.

The aim of this study was to investigate the impact of thrombolytic treatment on the clinical course of patients with thromboembolic or atherothrombotic cerebral artery occlusion. Such patients suffered from occlusion of the basilar artery, carotid artery, or the main stem middle cerebral artery. Another aim was to investigate whether the extent of reperfusion and of collateral circulation was of any predictive value for the outcome of patients treated with fibrinolysis. In addition, we wished to look at further prognostic parameters concerning risk and benefit of thrombolytic treatment.

Thrombolysis may achieve recanalization in cases of occlusion of the cerebral vessels. If therapy is initiated in good time, development of cerebral infarction may be at least partially prevented. Thrombolytic treatment was performed in 14 patients at the Wagner-Jauregg Hospital within a period of one year. Urokinase was given locally, while rtPA was applied locally and/or systemically. 4 patients had an occlusion of the internal carotid artery, 6 an occlusion of the middle cerebral artery, and 4 an occlusion of the basilar artery. Complete recanalization was achieved in 6 patients, partial recanalization in 4, and no recanalization in 4. The neurological outcome of the cases with complete recanalization was good with the exception of one patients who died. Partial recanalization resulted in a fair outcome in 2 patients, while the other 2 died. 3 out of the 4 patients in whom no recanalization was achieved died. Our findings show that this form of therapy may considerably improve the natural history of the disease, provided recanalization is achieved in good time. They encourage us to continue this form of therapy and to work at improving the therapeutic criteria.

The diagnostic value of SPECT in Pick’s disease is discussed on the basis of two cases. Personality changes predominated in both of them. Atrophy of the frontal and temporal lobes was seen on CT only in one of the two female patients, who was in a stage of advanced dementia. SPECT showed reduced frontal accumulation in both cases in analogy to PET studies. The results of the present study demonstrate that a tentative diagnosis of Pick’s disease can either be excluded or substantiated with the help of SPECT.

A girl with non-contributory family history, at the age of 7 years developed a recurrent ataxic-spastic syndrome followed by disorders of consciousness and seizures. She died in a decerebrate state at the age of 10 9/12 years. Diffuse EEG abnormalities changed in accordance with the clinical course. CSF findings were always negative. Brain biopsy performed at the age of 9 5/12 years was non-diagnostic. No clinical signs of adrenal insufficiency were present. Neuropathological examination disclosed severe demyelination of the cerebral white matter with formation of large periventricular cavities, relative sparing of the subcortical arcuate fibers, and peripheral myelin breakdown of the orthochromatic (neutral fat) type. There was complete absence of inflammatory lesions, comparative preservation of axons and oligodendroglia with moderate astroglial reaction. The optic system and cerebellum were not involved. Additional postanoxic changes were seen in the thalamus and hippocampus. The sporadic case is suggested to represent a cavitating form of neutral fat (simple orthochromatic) leukodystrophy which is to be separated from Schilder's diffuse sclerosis and adrenoleukodystrophy. The etiology of the disorder is unknown.

Recently, [123I]Ro16-0154 has been introduced as a potential benzodiazepine (BZD) receptor imaging tracer for SPECT. We investigated the biodistribution of [123I]Ro16-0154 in humans and compared it with the animal data. There was a rapid and high 123I-uptake in the brain comparable to rCBF. In the following images, however, regionally different changes were observed, resulting in a subsequent intracerebral retention parallel to the known distribution of BZD receptors. The results suggest that [123I]Ro16-0154 is of potential clinical use as a BZD receptor imaging agent.

21 members of a large kinship with autosomal dominant CMT showing typical clinical findings were studied electroneurographically, with visual evoked potentials (VEP) and with blood group markers. In clinically affected members, the mean motor nerve conduction velocity (NCV) of the median nerve was found to be 17.5 m/s (SD 2.4). Contrary to previous genetic linkage studies in CMT families with comparable slow motor NCV, blood group typing in this family excluded close linkage of HMSN I to Duffy locus, which may indicate the existence of another subgroup in CMT neuropathy. Mean latencies of VEP, in both clinically affected and unaffected members, showed no pathological alterations when compared to normals. There was no correlation between NCV and P 100 latencies, but significant variation of P 100 latencies in families of twin brothers could be demonstrated. As already suggested by other authors, our findings may also indicate heterogeneity in this neuropathy.

Fifty-eight patients suffering from cerebrovascular ischaemic disease were examined by means of somatosensory evoked potentials (SSEPs). The early components during the first 50 msec were evaluated ( N13 , P15 , N20 , P28 , CCT = N13 - N20 ). The patients were divided into 4 groups according to the affected vascular region and the reversibility of the symptoms. (1) Reversible ischaemic attacks in the vertebro-basilar artery region: 16 patients. (2) Reversible ischaemic attacks in the internal carotid artery region: 14 patients. (3) Non-reversible ischaemic deficits in the internal carotid artery region: 16 patients. (4) Diffuse vascular encephalopathy: 12 patients. The two groups suffering from reversible ischaemic attacks did not show any significant SSEP differences, either when the right and left sides were compared, or when the groups were compared to a control group. Patients with non-reversible ischaemic deficits of the carotid artery system showed a significant difference of the N20 - P28 amplitude compared to controls; it was increased on the non-affected side. Thelatencies of N20 and CCT showed a significant increase on the affected side; P15 components revealed significant delays on both sides. In patients with diffuse vascular encephalopathy significant delays of N13 and P15 were found on both sides, whereas the CCT was unaffected on both sides. The results are discussed in view of the topologic aspects and reversibility of symptoms.

A radioactive tracer was injected into the lumbar spinal fluid immediately after radiculography in 109 patients. On the basis of the distribution of the tracer in the CSF three different types of alteration of normal CSF circulation were observed: persistence of the tracer in the lumbar region, penetration of the tracer into the epi-and/or subdural space in the lumbar region and CSF leakage through the meningeal puncture site into the puncture tract. A correlation between the disturbance in the CSF circulation and the occurence of headache following radiculography could be demonstrated. The use of a thin puncture needle diminisches both the severity of disturbances of the CSF circulation and the frequency and intensity of headache.

The side effects associated with the use of Iotrol were determined in 100 patients and compared with metrizamide and iopamidol in two double-blind studies. The relevance of the distribution of the contrast medium in the CSF space to the occurrence of headache is discussed. The low persistence of iotrol in the brain parenchyma is demonstrated on CT density profiles, compared with metrizamide and iopamidol. Iotrol seems to be the safest contrast substance for intrathecal use.

Creutzfeldt-Jakob disease (CJD) may present itself with cerebellar signs initially and in the course of the disease. In addition to the classical triad of morphological changes, i.e. status spongiosus, neuronal loss and astrocytic proliferation, in the cerebral cortex and basal ganglia, there may be cerebellar involvement with selective loss of the granule cells with associated astrocytic gliosis or sponginess and relative sparing of the Purkinje cells. Occasional systematized degeneration of the paleocerebellum, “kuru-like” plaques in the cerebellum and chromatolytic neurons in the striatum are similarities between CJD and kuru. Among 17 proven cases of CJD cerebellar onset with or without mental changes was present in 47%, and cerebellar ataxia in the course of the disease was prominent in 75%. Cerebellar lesions were noted in 81%, and were more severe and advanced than cerebral involvement in 5 cases with cerebellar onset. Kuru plaques were not seen. CJD presenting with ataxia and cerebellar symptoms constitutes about 17% of all cases of CJD reported to date, and should be considered in the differential diagnosis of cerebellar disease in middle-aged patients. The similarities and dissimilarities of this subtype of CJD to kuru and other transmissible slow virus spongiform encephalopathies in man and animals are discussed.

In den medianen Gebieten des Septums beim Kaninchen wird eine Schrittmacher-Zone fur die bei diesen Tieren charakteristisch mit der „arousal reaction“ verbundene hohe rhythmische Wellentatigkeit im Hippocampus und Diencephalon beschrieben.

On proprioceptive stimulation or after the intravenous administration of physostigmine rabbits show a very regular 4–7/sec activation within the rhinencephalon and diencephalon, while in cortical leads a simultaneous reduction of voltage occurs which is characteristic for the arousal reaction. The regular activity can be modified by electrical stimulation at a circumscript median area within the septum.

In an earlier investigation it was found that ganglioside GM2 the typical neuronal storage product in GMz-gangliosidosis, was accumulated also in the cerebrospinal fluid (CSF) of a Tay-Sachs patient. The asialo derivative of ganglioside GM2, GM2, which is a concomitant storage product in the brain of these patients, was not detected in the CSF of the patient investigated (BERNHEIMER, 1968). In the present account, a report is made on the accumulation of ganglioside GM2 and of GM2 in the CSF of a patient affected by Sandhoff disease.

In routine diagnosis, single photon emission computed tomography (SPECT) may also reveal typical patterns of abnormal tracer uptake (Cohen et al., 1986; Jagust et al., 1987). To develop this method further, we investigated patients with dementia by SPECT and by CT and correlated the findings to the results of clinical classification

Bei der Borreliose entwickeln sich die neurologischen Manifestationen mit einer Latenz von Wochen bis Monaten und sind in etwa 15% der Falle anzutreffen. Die charakteristischen Zeichen der neurologischen Beteiligung sind Meningitis, kranielle Neuritis und schmerzhafte Radikulitis. Eine Beteiligung des ZNS wurde in einer groseren Anzahl der Falle beschrieben. Wir berichten hier uber 2 Patienten, bei denen zentralnervose Symptome auftraten und die kernspintomographisch untersucht wurden.

In 107 patients the EEG after sleep deprivation was performed. The patients have been divided in three groups: 1) with clinically unequivocal, 2) equivocal and 3) no epileptic seizures. All the patients where subdivided in those with and those without anticonvulsive medication. In patients with a previous normal EEG, sleep deprivation had the most activating effect regarding focal or generalized spikes or spike wave complexes in group one. However, patients without medication showed more often activation compared with untreated patients. In the second group the activation was less pronounced, again presenting the same relation between treated and untreated patients. Patients with no seizures as well as a control group of 20 volunteers had no activation at all.

the international classification of epilepsies is presented. This classification is based on pathophysiological, clinical, electroencephalographic, prognostic and therapeutic considerations. The application according to 3 principal types of epilepsies is simple and effective.

25 comatose patients suffering from severe cerebral lesions of different etiology were examined during barbiturate-therapy by Glasgow-Pittsburg-Coma-Scoring-System (GPCS), EEG, somatosensory and brainstem acoustic evoked potentials. The findings were correlated in view of prognostic prediction and importance for monitoring. A modified form of the Glasgow-Outcome-Score (GOS; independent-survival, dependent-survival, dead) was used for evaluating the outcome. In case of an initial GPCS less than 10 points none of the patients survived, in case of GPCS greater than 10 points 11 out of 19 patients survived. The latter relation of survival was also found in patients with improving or impairing scores during the observation period. In case of initial burst-suppression pattern in the EEG 7 out of 11 patients survived, in case of diffuse abnormalities with or with-out additional focal signs - 4 out of 10 patients survived, but in the latter there was none with an outcome of independent survival. All patients with an isoelectric EEG died. In case of bilateral recording of scalp- SEP 7 out of 11 patients survived, in case of unilateral loss of scalp-EP 4 out of 8 patients survived, but in the latter cases none with an outcome of independence. All patients with initial bilateral failure of scalp-SSEP or loss during the observation period died. In case of bilateral registrable BAEP (wave I to V) 11 out of 17 patients survived. All patients with initial uni- or bilateral failure of those potentials or loss during the observation period died.(ABSTRACT TRUNCATED AT 250 WORDS)

Both IMP and HMPAO are lipophilic substances with high blood brain barrier permeability and sufficiently long constant retention in the brain parenchyma to enable SPECT to be carried out with a computer controlled Gamma camera. Both tracers are almost completely cleared from the blood during a single passage through the brain. Hence, the regional distribution of activity in the brain is proportional to the regional cerebral blood flow. Computerized acquisition and data processing result in 16 mm thick tomograms at a spatial resolution of 12 mm, which enable clinicians to detect and characterize the pathogenesis and the development of cerebral disorders in terms of altered function. At present, SPECT can be used in daily clinical routine (final SPECT images are available 30 min after the investigation) in cerebrovascular diseases and, because of the coupling of metabolism to cerebral blood flow, in disturbances of cerebral blood flow due to pathological changes of brain metabolism, i.e. in epilepsy and in degenerative disorders. The forthcoming application of physiologically highly specific tracers (e.g. receptor ligands) as a means of studying the distribution of receptors and drugs in the brain will further enlarge the eventual role of SPECT in clinical management.

In the EEG after sleep deprivation paroxysms with spikes and spike wave-complexes as well as paroxysms with slow waves can be seen. The paroxysms occur either spontaneously (it means at any time during the record) or at moments of shifting vigilance. These moments are characterized by sudden changes of the EEG frequency for instance by transition from one sleep stage to another. Paroxysms with spikes or spike wave-complexes occur mainly at the transition from lower to higher levels of vigilance and are accompanied by abnormal K-complexes and abnormal photosensibility. Paroxysms of slow waves occur mainly at the transition from higher to lower levels of vigilance, abnormal K-complexes and abnormal photosensitivity are lacking but in some cases the before diffuse abnormal EEG is improved after sleep deprivation. It assumed that we are dealing with two different types of reaction.

Fourteen cases of totally or predominantly unilateral ventricular reflux and stasis of intrathecally injected radioisotope or contrast medium were demonstrated by scintigraphy or computed tomographic cisternography. All showed asymmetric enlargement of the lateral ventricles and nine had ipsilateral brain lesions. Four case reports are presented. The pathophysiologic mechanism of communicating hydrocephalus and possible causes of unilateral ventricular reflux are discussed, as well as indications for ventricular shunt installation.

Die Sequenzszintigraphie (Radionuklidangiographie, Isotopenangiographie, sequentielle Hirnszintigraphie) ist eine der wichtigsten nichtinvasiven Untersuchungsmethoden bei zerebralen, insbesondere umschriebenen Durchblutungsstorungen. Beurteilt werden die Analogdarstellung der Karotiden und die Passage des Bolus durch das intrazerebrale Gefassystem (3, 5, 7, 8), sowie die computerunterstutzt gewonnenen Daten uber Perfusion und Transitzeit (1, 4, 9). In einem unterschiedlich hohen Prozentsatz konnen Gefasverengungen und Verschlusse im Karotissystem (3, 5, 7, 8) und Perfusionsdifferenzen (4) erfast werden.

In order to increase the accuracy of preoperative "type-diagnosis" fifty meningiomas in various sites were investigated by brain-scan, and routine angiography. Some cases in addition had external carotid angiography and angioscintigraphy of the external and internal carotid. By tabulating the findings, it is possible in 90% of cases to provide a pre-operative "type-diagnosis" of meningioma. Details are given regarding the influence of the tumour site on the ability to demonstrate the tumour through branches of the external or internal carotid, as well as "filling defects" or isotope uptake in angioscintigraphy. The reasons are discussed for the lack of agreement about the size of the tumour, in angiogram and angioscintigram, as well as in the brain-scan, in 15 out of 34 meningiomas.

We evaluated 24 patients with radiologically verified cervical disk prolapse. EMG abnormalities appeared in 67% of cases studied; dermatomal somatosensory evoked potentials revealed 85% abnormal findings on the affected side, but also revealed abnormalities in adjacent segments. In 38%, F responses were abnormal. We found electrodiagnostic abnormalities at levels without a disk prolapse, probably due to degenerative spondylopathic changes and beginning consecutive vascular compromise.

21 comatose patients were examined by somatosensory evoked potentials (SSEP). The findings were correlated with the stage of brainstem herniation, the EEG and the outcome. We evaluated the early components of the SSEP (N10, N13, N14, P15, N20) in view of presence, latency and interpeak-latency of the potentials. In most cases the percentage of abnormal SSEP increased from caudal to rostral registration sites, but the potential P15 and N20 were equally abnormal. The progression of herniation correlated with increasing abnormality of the potentials. SSEP over the scalp (P15, N20) could not be registered in patients without any EEG-activity (isoelectric). Mean values of latencies and the interpeak-latencies were significantly prolonged in all cases with fatal outcome. Our findings suggest SSEP as a useful tool in the evaluation of brain-dysfunction in comatose patients.

Classification of the hereditary motor and sensory neuropathies is discussed and findings reported in the recent literature are compared to our own findings in a kinship with autosomal dominant CMT. Previous studies in CMT-families with comparable slow nerve conduction velocities had shown positive linkage of this hereditary neuropathy to the Duffy blood group locus; however, blood group typing in the recently studied kinship excluded close linkage, which may indicate the existence of another sub-group in this entity. Testing of visually evoked potentials in this kindred demonstrated significant differences in P 100 latencies of the families of twin brothers. This intrafamilial difference may also be an expression of heterogeneity.

Kopfschmerz ist ein Alarmsignal bei einer Fulle von Erkrankungen des Schadelinneren sowie von verschiedenen Strukturen im Bereiche des Schadels, aber auch von Prozessen, die vom Halsbereich ausgehen. Nicht nur Erkrankungen mit einem morphologischen Substrat (z. B. ein entzundlicher Prozes im Kieferbereich), sondern auch funktionelle Geschehen (z. B. abnorme vasomotorische Reaktionen, die nicht immer vom Migranetyp sein mussen) fuhren zu Kopfschmerzen. Das diagnostische Denken mus deshalb vielfaltig sein und man sollte sich ein diagnostisches Schema fur eine gezielte diagnostische Vorgangsweise vor Augen halten. Wenn auch die Klassifikation der Kopfschmerzen nach dem Ad-hoc-Komitee aus dem Jahr 1962 stammt, ist es mit Einschrankungen noch immer brauchbar, und es gibt bisher kein besseres. Es ist deshalb zweckmasig, sich nach diesem Schema zu halten. Es weist folgende Einteilung auf: I. vaskularer Kopfschmerz vom Migranetyp, II. Muskelkontraktionskopfschmerz, III. kombinierter Kopfschmerz (Kombination von I. und II.), IV. Kopfschmerz durch nasale vasomotorische Reaktion, V. Kopfschmerz durch psychische Storungen (Konversion, affektive Storung), VI. nichtmigranoser vaskularer Kopfschmerz, VII. Dehnungskopfschmerz, VIII. Kopfschmerz durch kranielle Entzundungen XI.–XIII. Kopfschmerz durch Erkrankungen des Auges, der Ohren, der Nase, der Sinus, der Zahne oder anderer kranieller und Nackenstrukturen, XIV. kranielle Neuritiden, XV. kranielle Neuralgien. Die apparativ-diagnostischen Moglichkeiten werden im folgenden fur die einzelnen relevanten Kopfschmerzformen dargestellt.

19 patients were treated with valproic acid (VPR) in combination with classical anticonvulsants (phenytoin, phenobarbitone, primidone, carbamazepine). Patients with a mean serum concentration of 340 micron moles/l showed a marked improvement as to the frequency of seizures or were even completely free from seizures, provided that the other anticonvulsants were also given in the therapeutic range. Cases showing only a slight reduction in seizure frequency or no improvement had a mean serum level of 229 micron moles/l. This investigation shows that in severe cases of epilepsy treated by combined therapy all given anticonvulsants must reach therapeutic levels to achieve effective control of seizures in most patients.